MEDICARE: CLINICAL RESEARCH WEST COAST.INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1100X	Research Clinic/Center

General Provider Information

NPI Number	:	1114311370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL RESEARCH WEST COAST.INC

Provider Business Mailing Address
First Line	:	3660 CENTRAL AVE STE 9
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8258
Country	:	US
Telephone Number	:	239-208-9677
Fax Number	:	239-208-9679

Provider Business Practice Location Address
First Line	:	3660 CENTRAL AVE STE 9
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8258
Country	:	US
Telephone Number	:	239-208-9677
Fax Number	:	239-208-9679

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CHRIS RICARDO MARTINEZ
Credential	:
Telephone Number	:	954-665-0430

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	06/20/2018

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